Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of tuberculous pleural effusion

Introduction: Pleural fluid adenosine deaminase (pfADA) is a simple, rapid and inexpensive surrogate marker for tuberculous pleural effusion (TPE). A nationwide cut-off of 40 U/L is currently used based on overseas data. There is a need to optimise the diagnostic utility of pfADA by establishing a l...

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Autores principales:	Nai-Chien Huan, Inn Shih Khor, Hema Yamini Ramarmuty, Ming Yao Lim, Kai Choon Ng, Alfieyanto Syaripuddin, Qin Zhi Lee, Wee Jing Teo, Kunji Kannan Sivaraman Kannan
Formato:	article
Lenguaje:	EN
Publicado:	SAGE Publishing 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/b0eb988403584e31a626af171982c63b
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spelling	oai:doaj.org-article:b0eb988403584e31a626af171982c63b2021-12-01T02:03:55ZOptimising the utility of pleural fluid adenosine deaminase for the diagnosis of tuberculous pleural effusion2010-10582059-232910.1177/2010105820978998https://doaj.org/article/b0eb988403584e31a626af171982c63b2021-12-01T00:00:00Zhttps://doi.org/10.1177/2010105820978998https://doaj.org/toc/2010-1058https://doaj.org/toc/2059-2329Introduction: Pleural fluid adenosine deaminase (pfADA) is a simple, rapid and inexpensive surrogate marker for tuberculous pleural effusion (TPE). A nationwide cut-off of 40 U/L is currently used based on overseas data. There is a need to optimise the diagnostic utility of pfADA by establishing a local cut-off value. In this study, we aimed to describe the demographics and clinical characteristics of patients with TPE and non-TPE; determine the sensitivity and specificity of current pfADA of 40 U/L; and establish a new local pfADA cut-off for TPE. Methods: We conducted a single-centre, observational, prospective study of patients with exudative pleural effusion and pfADA measured from 1 October 2019 to 30 April 2020 at Queen Elizabeth Hospital, Malaysia. Results: The diagnosis of analysed patients ( n = 93) included TPE ( n = 41), malignancy ( n = 28), parapneumonic effusion ( n = 12) and other causes ( n = 12). The mean pfADA was 51.15 U/L (standard deviation (SD) = 13.77) among TPE group and 18.86 U/L (SD = 12.33) among non-TPE. When analysis was restricted to TPE patients, the local pfADA cut-off is 29.6 U/L, with a sensitivity of 97.6% and specificity of 90.4%. The current pfADA of 40 U/L has a sensitivity of 87.8% and specificity of 92.3%. Conclusion: We established a local pfADA cut-off of 29.6 U/L for TPE. Optimising the utility of pfADA helps to enhance clinicians’ treatment confidence of TPE when initial work-up is inconclusive.Nai-Chien HuanInn Shih KhorHema Yamini RamarmutyMing Yao LimKai Choon NgAlfieyanto SyaripuddinQin Zhi LeeWee Jing TeoKunji Kannan Sivaraman KannanSAGE PublishingarticleMedicineRENProceedings of Singapore Healthcare, Vol 30 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Nai-Chien Huan Inn Shih Khor Hema Yamini Ramarmuty Ming Yao Lim Kai Choon Ng Alfieyanto Syaripuddin Qin Zhi Lee Wee Jing Teo Kunji Kannan Sivaraman Kannan Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of tuberculous pleural effusion
description	Introduction: Pleural fluid adenosine deaminase (pfADA) is a simple, rapid and inexpensive surrogate marker for tuberculous pleural effusion (TPE). A nationwide cut-off of 40 U/L is currently used based on overseas data. There is a need to optimise the diagnostic utility of pfADA by establishing a local cut-off value. In this study, we aimed to describe the demographics and clinical characteristics of patients with TPE and non-TPE; determine the sensitivity and specificity of current pfADA of 40 U/L; and establish a new local pfADA cut-off for TPE. Methods: We conducted a single-centre, observational, prospective study of patients with exudative pleural effusion and pfADA measured from 1 October 2019 to 30 April 2020 at Queen Elizabeth Hospital, Malaysia. Results: The diagnosis of analysed patients ( n = 93) included TPE ( n = 41), malignancy ( n = 28), parapneumonic effusion ( n = 12) and other causes ( n = 12). The mean pfADA was 51.15 U/L (standard deviation (SD) = 13.77) among TPE group and 18.86 U/L (SD = 12.33) among non-TPE. When analysis was restricted to TPE patients, the local pfADA cut-off is 29.6 U/L, with a sensitivity of 97.6% and specificity of 90.4%. The current pfADA of 40 U/L has a sensitivity of 87.8% and specificity of 92.3%. Conclusion: We established a local pfADA cut-off of 29.6 U/L for TPE. Optimising the utility of pfADA helps to enhance clinicians’ treatment confidence of TPE when initial work-up is inconclusive.
format	article
author	Nai-Chien Huan Inn Shih Khor Hema Yamini Ramarmuty Ming Yao Lim Kai Choon Ng Alfieyanto Syaripuddin Qin Zhi Lee Wee Jing Teo Kunji Kannan Sivaraman Kannan
author_facet	Nai-Chien Huan Inn Shih Khor Hema Yamini Ramarmuty Ming Yao Lim Kai Choon Ng Alfieyanto Syaripuddin Qin Zhi Lee Wee Jing Teo Kunji Kannan Sivaraman Kannan
author_sort	Nai-Chien Huan
title	Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of tuberculous pleural effusion
title_short	Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of tuberculous pleural effusion
title_full	Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of tuberculous pleural effusion
title_fullStr	Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of tuberculous pleural effusion
title_full_unstemmed	Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of tuberculous pleural effusion
title_sort	optimising the utility of pleural fluid adenosine deaminase for the diagnosis of tuberculous pleural effusion
publisher	SAGE Publishing
publishDate	2021
url	https://doaj.org/article/b0eb988403584e31a626af171982c63b
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Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of tuberculous pleural effusion

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